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Opioid Safety After Surgery

Hospital for Special Surgery prescribes opioid medications conservatively. We do not routinely prescribe long-acting opioids. We do not prescribe more than a short-course of short-acting opioids, and in general, we do not refill lost, stolen, or destroyed prescriptions.

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Opioids and the Surgical Process

Prior to surgery, patients will receive education on the various aspects of the surgical process, including opioid prescription management. Patients with a prior history of opioid use may be referred to our Chronic Pain Consult team for further evaluation. Long-term opioid use impacts anesthetic and pain management options and requires further evaluation to ensure the highest quality of care.

The day of surgery, patients will have the opportunity to discuss their anesthetic and pain medicine options with their anesthesiologist and surgeon before the anesthetic plan is set.

Opioid Prescription Safety Tips

  • Take your medications only as directed by your doctor. DO NOT share your medications with anyone - sharing your prescriptions is illegal and could endanger other people’s health.
  • If you are taking benzodiazepines (Xanax, Valium, etc.), consult with your prescriber on the management of these medications with opioids. Combining opioids with these medications can slow or stop breathing. DO NOT mix opioid medications with alcohol. Do not drive or operate heavy machinery.
  • Store your prescriptions securely in their original containers. Keep them out of sight and out of children’s reach, preferably in a locked cabinet or high shelf.

Video – Safe Opioid Use & Storage

Opioid Tapering

You will eventually need to slowly reduce and stop taking opioids. This is called “tapering.” For more information about tapering, visit A Patient’s Guide to Opioid Tapering.

Video – How to Taper Off Opioids After Surgery

Opioid Disposal

  • Dispose of opioid medications immediately after your pain symptoms have resolved.
  • Unused medications are best disposed of at a take back facility/pharmacy – search for public disposal locations.
  • HSS also has a medicine disposal drop box on our main campus in the Belaire Building at 525 East 71st Street in New York City.
  • Patients discharged from HSS with an opioid prescription will receive DisposeRx® powder to safely and easily dispose of unused opioids.
    • Please see the video below for more information about opioid disposal, including instructions on how to use the DisposeRx® powder:

Video – How to Safely Dispose of Opioids

Misuse and Overdose Risks

  • When misused, prescription medications may be just as dangerous as illegal drugs.
  • Misusing your medications can have serious consequences including lack of energy, inability to concentrate, physical weakness, nausea, vomiting, and suppressed breathing to the point of death. If you have not taken your medications as directed, and you experience any of these symptoms, please go immediately to an emergency room.
  • If you feel that you have taken more medication than what was prescribed, seek immediate medical attention.
  • Misusing your medications may also lead to addiction – it is imperative that you take your medications only as prescribed.
  • As you recover from surgery your opioid use should decrease. If severe pain persists or your opioid requirements increase, please notify your surgeon.

Taking Opioids & Benzodiazepines (Anxiety Medications) at the Same Time

While opioids and benzodiazepines can be important for treating pain, anxiety and other health conditions, taking them at the same time can put you at increased risk for accidental overdose. 

If your doctor permits you to take opioids and benzodiazepines at the same time, there are some safety practices you should know.

How can you reduce your risk?

  • Talk to your doctor about the risks and benefits of using these medicines.
  • Ask your doctor if there are safer medicines to use instead, or if you can slowly reduce your doses.
  • Never combine opioids with other substances that can suppress breathing, such as sleep aids, alcohol, marijuana, or other drugs.
  • However, don't stop taking medicines without talking to your provider first. Stopping medicines too quickly can also cause serious problems, including withdrawal symptoms. 
  • Some medical conditions such as sleep apnea can increase your risk of complications or accidental overdose.
  • Consider getting Naloxone in case of emergency. Ask your pharmacy how you can get Naloxone.

Watch our video to learn more about best practices for safety, and to learn what you should ask your doctor.

Video – Opioids and Benzodiazepines: Best Practices for Safety

How to Use Naloxone

Naloxone is a medicine used to reverse opioid overdose. Just as someone with allergies might carry an EpiPen, or someone with diabetes may carry Glucagon, Naloxone is meant for emergencies and can save lives.

Naloxone only works on opioids, including heroin, fentanyl, and prescribed opioid medications. 

Signs of an overdose can include:

  • A pale or clammy face,
  • Small, constricted “pin-point” pupils,
  • Limp body,
  • Blue or purple fingernails or lips,
  • Gurgling noises or vomiting,
  • The person is difficult to wake or is unable to speak,
  • The person’s breathing or heartbeat slows or stops.

You can learn how to use Naloxone in our video: “How to Use Naloxone: Reversing an Opioid Overdose.”

Video – How to Use Naloxone: Reversing an Opioid Overdose